Guarded Prognosis

by Richard L. Mabry MD

  Henry imagined that getting his records from Dr. Gershwin’s office would be difficult—talking with the staff, explaining why he wanted copies of the material, even arguing if necessary. He was wrong. A phone call gave him the information he needed. If he submitted the required paperwork, copies of the records and X-rays would be available for him to pick up the next day. The nurse told him they usually sent them to the other doctor, but since Henry was a physician, they’d bend the rules a bit.

  The next hurdle to clear was getting an appointment with the doctor he’d chosen for a second opinion. He dialed the number for Dr. Ross’s office, expecting to work his way through a maze of recorded voices and options. Instead, he found the call was answered by a real, live person. “I need an appointment to see Dr. Ross,” he said.

  “Were you referred by your doctor?”

  “I’m a physician—Dr. Henry Taggart. I’ve seen Dr. Gershwin at the medical center, but I want a second opinion. I’d like that to come from Dr. Ross.”

  The receptionist said, “One moment. Let me see what’s available. I presume you want this quickly.”

  “Please.” Now that he was ready to take the leap, Henry wanted an appointment immediately, but he knew that wasn’t possible. After he assured the woman at the computer that he could get his doctor’s notes and copies of the X-rays and bring them with him, they settled on a time on Thursday, a little more than two days away.

  All that followed was a confirmation of his insurance coverage and a request that Henry go to their website and complete the new patient information. He hung up, made a note to get those papers filled out tonight, and settled down to do the hardest thing for him—as a surgeon and as a patient. Wait.

  Caden didn’t like to keep people waiting. He tried to stay on time with his appointments, although it didn’t always work that way. But when someone took more than the allotted time, he asked his staff to advise the patients waiting about the delay (and, when it was possible to do so, the reason). That’s just the way he was.

  That was probably the reason he felt a bit ill at ease sitting next to Mel Sewell in the man’s inner office while the two DEA agents cooled their heels in the lawyer’s waiting room.

  “Relax,” Sewell said. “My main duty here is to protect your rights, and if it involves keeping those guys waiting while we confer, so be it.”

  Doctor and lawyer were seated next to each other at the table in one corner of Sewell’s office. Two vacant chairs across the table from them awaited the men in the waiting room, but only after the attorney finished talking with Caden.

  “Now, you’ve told me pretty much how it went down and where we are,” Mel said. “Let me confirm though. They didn’t have a warrant? They didn’t show anything saying they had authority to investigate?”

  Caden shook his head.

  Mel gestured with his reading glasses. “Then they were fishing. They had a few instances where your DEA number was used in false prescriptions, but nothing to indicate you had anything to do other than being an innocent victim. They wanted to look around your office setup, and you let them use you.”

  Caden felt a blush creeping up his cheeks. “When these two guys showed up in my office, flashed their badges, and hinted about the bad things that were going on that might involve me, I was anxious to cooperate. Honestly, I was scared not to. But it’s been a one-way street since then.”

  Sewell gave him a look that invited more information.

  “They’re keeping me in the dark about whether I’ve done anything wrong. It was almost as though they were holding it over my head. So, I finally decided that it was in my best interest to get legal counsel instead of just meekly going along with everything they want.”

  “And that was a wise move, although it would have been better if you’d done it as soon as they walked in the door,” Mel said. “Before we call them in, let me tell you what I’ve found out with a few phone calls.” He flipped through the pages on the legal pad in front of him. “There are indeed agents named Darren Neilson and Jerry Harwell based out of the Seattle office. Their pictures match the description you gave me. They were transferred there from DC and New York respectively. Neilson has a history of being just a little suspect, but nothing was ever proven. Harwell has one accusation in his personnel jacket of taking a payoff, but when the claim was investigated nothing was found.”

  “I never thought to check up on them,” Caden said.

  “Some of this information came through back channels,” Mel replied. “The Seattle office of the DEA ordered them sent here because there seems to be a drug ring in Freeman. They were given this assignment because no one here knew them.”

  “That’s what they told me.”

  Sewell turned a page on his legal pad. “Your office seemed to be where most of the illegal prescriptions originated. They didn’t have enough to apply for a search warrant, so the agents blustered in and tried to frighten you into cooperating. And you did.”

  “So, what do I do now?”

  “First, get them to admit that they’ve found nothing on you. Then offer them your continued assistance, in return for a free exchange of information.”

  They conferred for a few more minutes before Mel said, “Well, let’s have them in and see what we can work out.”

  He went to his desk and called his secretary on the intercom. “Please show the two gentlemen in.”

  Mel met them at the door and escorted them to their chairs. When everyone was seated, he said, “Gentlemen, I’m sure you won’t mind showing me your credentials.” He waited until the two wallets with badges and ID cards were in front of him. Mel copied the information onto a fresh page of his yellow legal pad before shoving the badge cases back toward the men.

  Neilson appeared frustrated by what had already gone on. “We don’t appreciate the way—”

  Mel raised his hand, palm outward, and waited until the room was quiet. “My client has been quite cooperative in allowing you two access to his practice’s routine—especially in the absence of a warrant or court order. And he’s willing to continue to be helpful, but it’s a two-way street, starting now.” He looked first at Neilson, then at Harwell. “So, who’d like to start the flow of information back in our direction?”

  Beth was waiting for Caden to come through the door. He dropped his backpack and stepped into her arms for the hug and kiss they always exchanged when he came home. But when he turned loose, he sniffed and frowned.

  “What’s for supper? I have a lot to tell you.”

  “As do I,” Beth answered. “And we can tell each other all about it over dinner—at RJ’s.”

  Caden had unbuttoned the top button of his shirt and tugged his tie loose as he came in the door. Slowly, he re-did all that. “Fine. I don’t mind taking you out to dinner, but what are we celebrating?”

  “You’ll see.”

  Fifteen minutes later, they sat in a back booth of their favorite restaurant. R.J. Terrell himself seated them, placing menus in front of them. “We don’t see you folks much anymore,” he said. “Must be sort of a special occasion.”

  Caden nodded, although Beth was certain from the look on his face that her husband had no idea what it was. “I think tonight I’d like one of RJ’s specialties. How do you feel about splitting a Chateaubriand?”

  She could see the wheels turning in Caden’s head. The Chateaubriand was essentially a large steak, the choicest cut, cooked with a sauce that always made Caden’s mouth water. There were potatoes and other vegetables on the side, but the meat was what he always talked about. Beth never tried it at home, but they both always enjoyed it at RJ’s.

  “Sounds great to me, but I still want to know what the occasion is.”

  “I talked with Rose this afternoon. Actually, I called to see if you wanted to join me for dinner out. Instead, I got some interesting information from her, information that gave me an idea.”

  “What? Oh, did she tell you about her husband’s new job and the upcoming move? In all t
hat’s been going on, I sort of pushed that news to the back of my mind. She’s going to start the process of getting some applicants.”

  Beth shook her head. “No, she isn’t.”

  Caden frowned. “Didn’t I tell her to do that?”

  “And I told her to stop. When I found out about this, I decided it was a great opportunity for me to get back to work.” She took a deep breath and plunged on. “I’m a trained, certified, credentialed nurse who’s been sitting at home because you want to eventually start a family. Well, that process hasn’t produced any results, and until it does, I’m ready to work.”

  He opened his mouth, but she went right ahead.

  “Rose can train me. It shouldn’t take long for me to pick up the routine. I’m sure the nurses for the other two doctors will help as well. And before you open your mouth, I’ve heard all the arguments about wives working with their husbands, but I don’t see why we can’t do it.” She looked at her husband.

  Before Caden could answer, the waitress was at their table, asking to take their drink orders.

  “Two iced teas. And we’re going to share a Chateaubriand, medium-well, with all the trimmings.”

  “Very good,” the waitress said. “Sounds like this is some sort of a special evening.”

  Beth nodded. “I think it will be before we’re through.”

  Caden wiped his lips with the napkin and dropped it on the table. He’d eaten a bit more than his half of the steak, using a roll to mop up the last part of the sauce on his plate. Over dinner, Beth had managed to overcome each objection he raised. Finally, Caden gave in.

  “You know, I guess this solution has an advantage we haven’t covered. It gives your mother one less thing to complain about,” he said.

  “We’ll work on the rest of what you call her trifecta of complaints later, but until then I’m glad to get back into nursing.”

  When the waitress came to clear the dishes, both Beth and Caden passed on dessert but asked for coffee. They sat, each lost in their own thoughts, until they were served.

  Caden stirred sweetener into his coffee. “I have some news of my own I want to share with you.” Seeing her upraised brows, he continued. “I met with the two DEA agents and my attorney this afternoon.”

  “Tell me about it.”

  He looked around, but things were quiet at RJ’s that Monday evening. There was no one within earshot of the booth they occupied. “Mel Sewell told me I shouldn’t have rolled over and complied so easily with the requests of those men. Once he set some ground rules, they told me a bit more about their investigation. To begin with, they admitted they’ve found no evidence that I’m involved in what amounts to a drug ring centered here in Freeman.”

  “I never thought you were.”

  “You can be as pure as the driven snow, as the saying goes, but there’s still the possibility you can get caught up in the net. Once we established my innocence, the agents told me that thus far they’ve found my name and DEA number aren’t being used on written prescriptions for controlled substances. They’re being used via the EPCS.”

  “The what?” Beth asked.

  “This is something you’ve never really been involved with because you worked on a hospital ward. Doctors used to have to jump through a number of hoops to prescribe narcotics. They could call in an emergency prescription but had to follow it up with a written one within a day or two. Here in Texas, the EPCS system was adopted in 2010.”

  “I still don’t know what EPCS is.”

  “Electronic prescription for controlled substances. Not all doctors’ offices use it, but it’s nice for those prescribing narcotics frequently. We used to have to follow up an emergency phone prescription with a written one. That’s all changed.”

  “Tell me about the EPCS,” Beth said. “How does it work?”

  “A nurse or physician, under the authority of a qualified prescriber, can use this electronic system to send a controlled substance prescription to a pharmacy. There are things they have to do, some of which I don’t try to understand, because not all pharmacies are set up to receive these scripts. But we’ve been using this system in the office since right after it started up.”

  “For just you?”

  “No, for all three of the doctors. Our DEA number isn’t particularly secret, and each of our nurses is authorized to use the electronic system for all our prescriptions, not just narcotics. It saves a lot of writing for the doctors.”

  Beth took a sip of her coffee, then shoved it aside. “So, have the agents identified who’s doing this?”

  “Not yet. Prescriptions using each doctor’s DEA number have showed up at a number of pharmacies. This is a well-organized ring, and although the agents want to learn who the person or people involved are, they also hope to uncover the person who’s behind it.”

  “Will they still be around your office?”

  The waitress came by with a coffeepot. Caden checked with Beth, then declined and asked for the check.

  “Harwell says he’s about finished at my office, but they’ll both be in town for a bit longer.” Caden frowned. “I’m wondering if your showing up to start work there is going to make some waves.”

  “I think the nurses will accept me.”

  Caden shook his head. “As a nurse, I’m sure they will. But what if the person who’s been inputting the fake scripts thinks you’re there to spy on them?”

  11

  “Have you heard anything more about our near-crash on Saturday?” Beth said as she emerged from their bathroom on Tuesday morning.

  “My 9-1-1 call went to the sheriff, since the accident happened outside the city limits,” Caden said. He pulled on his socks and reached for his shoes. “I forgot to tell you they called me yesterday afternoon. The driver of that pick-up hit someone else later that morning, and they arrested him. He was a drunk teenager.”

  “Drunk at that time of the morning?”

  “The party he attended started on Friday night and was just breaking up when he hit us on Saturday,” Caden said. “I guess our accident didn’t have anything to do with this DEA investigation.”

  “I’d still be careful,” Beth said. “What do the nurses at your office wear?”

  “Uh, I haven’t paid much attention.”

  “I assume it’s scrub suits of some sort, covered by a jacket. Do the doctors insist on a certain color? Is there a style I need to match?” Beth laughed. “I doubt they wear white dresses and nurse’s caps like you see in some of the old movies.”

  Caden shook his head. “Why don’t you wear what you did at your last job? If there’s a problem, you can deal with it later.”

  Beth was pleased that her clothes from her prior work as a ward nurse still fit. She packed a lunch, in case there was no time to go out and eat. Was there anything else she needed to take? If so, she’d deal with it later.

  When she was ready to leave, Caden said, “Want to ride with me?”

  “And what do we do if you have an emergency case, or have to go by the hospital to see a consult? No, I’m a big girl. We’ll take two cars.”

  Beth arrived at eight o’clock and found a parking place with ease. She figured that her scrubs should have provided a clue, but the receptionist probably had no idea who she was or why she was there. She could just as easily have entered the suite to ask directions to some other office.

  “May I help you?”

  “I’m Beth, the new nurse. I don’t know if Dr. Taggart told Rose to expect me, but . . . ”

  The young blonde rose and extended her hand. “I’m Donna. Welcome.” She bent over and flipped a switch before she spoke. “Rose, come to the front, please.”

  In a moment, an older brunette, her glasses hanging by a chain around her neck, came through a door that apparently led to the treatment area. Beth guessed that the woman was in her mid-50s. She was a bit stout, although not obese. In addition to a watch on her left wrist, the woman wore a wedding ring on her left hand. She extended the right, and said,
“Welcome. Dr. Taggart didn’t call to give me a heads-up, but I spoke with his wife yesterday afternoon and she sort of led me to believe they had someone in mind for the position.”

  Obviously neither of the women had recognized Beth’s voice from the phone call. She had always left off her rings and other jewelry when she worked on a hospital ward, and she’d done that today when she donned what she considered her “nursing uniform.” Further, Beth hadn’t used her name when introducing herself to the receptionist.

  Would it be best to keep her identity as “the doctor’s wife” secret? No, there was no reason to start her employment with a lie. Besides, what if she wanted to go into his office and close the door? Neither she nor Caden needed to start that kind of rumor. Beth decided to go with the axiom she’d heard before: Tell the truth. That way, you don’t have to remember what you said.

  “Actually, Rose, I’m here to learn the ropes so I can be your replacement.” She extended her hand. “I’m Elizabeth Taggart, but everyone calls me Beth.”

  Caden walked into the front hall of his home and paused to sniff. He’d become used to entering and smelling the odors of that night’s dinner. But there was none of that. He hadn’t fully realized until then that he’d come to rely on his evening meal being ready shortly after he arrived home.

  He thought about it and realized the many things that Beth did to keep their house running—little things he’d taken for granted since their marriage. Grocery shopping. Laundry. Cooking. Cleaning. How would she have time to do all that now that she was working? Of course, he’d help, but would that be enough? He began to have second thoughts about her working as his office nurse.

  The house was quiet, and as he moved through it Caden realized that Beth wasn’t home yet. Should he call her cell phone? No, if she needed him, she’d let him know. Beth, along with the rest of the staff, was still at the office when he left to go to the hospital. His visit there, a couple of consultations and a bit of conversation with some of his colleagues, had taken a while. But shouldn’t Beth be home by now? He’d never given any thought to the things that had to be done by his nurse before she left for the day.